CHOOSING WISELY
www.choosingwiselycanada.org
tests because they think patients
expect it and patients want tests
and treatments even if they’re not
helpful. Patients can feel if they
didn’t get a script or test, the doctor
didn’t “take care of them.” There
are lots of reasons doctors order
We’re talking about areas
where there is unequivocal
evidence that these tests
don’t add value.
tests that are not necessary. Doctors worry about litigation. It takes
more time to explain to patients
why they don’t need a test rather
than to just order it. And often it’s
habitual practice patterns – when I
see a patient with X, I always order
Y. We’re asking doctors to challenge
those notions.
Q: What are some examples of tests
or procedures that may be unnecessary?
A: MRIs for low back pain, EKG
stress tests in people with no cardiac risk, antibiotics for sinusitis,
bone density scans when they’re not
needed. Preoperative tests such as
blood tests or chest X-rays in low
risk patients. For people with no
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DIALOGUE • Issue 1, 2014
cardiac risk who are undergoing
relatively minor procedures, there’s
no need for all those tests. We’re
not saying you should never order
these tests. We’re saying you should
discuss it with patients. Don’t routinely order them. We’re not talking
about grey zones where maybe
you should do it and maybe you
shouldn’t. We’re talking about areas
where there is unequivocal evidence
that these tests don’t add value.
Q: How do patients benefit?
A: High quality patient care is doing the right thing for people and
not doing something which might
be unnecessary or harmful. Unnecessary tests can lead to more tests
with false positives. If you do an Xray that’s not necessary you might
see an area that’s not normal. Then
you might get a CT scan. Then you
might get a needle biopsy – all of
which was unnecessary. So pursuing
false positives puts patients at risk
for even more invasive procedures,
not to mention anxiety.
Q: What has been the impact of the
campaign in the U.S.?
A: It’s a work in progress. The
campaign only started in 2012 and
it’s such a fragmented health-care
system. In Ontario, we are working
with ICES (Institute for Clini-
cal Evaluative Studies) to develop
an evaluation plan to determine
whether this campaign has an
impact on ordering of tests and
physician and public attitudes.
Q: Won’t some people see this as a
cost-cutting exercise in the guise of
improving patient care?
A: We’re not saying don’t order
these tests. We are saying don’t
order them routinely. It’s not a
cost-cutting maneuver. We are
not trying to cut needed care. It is
specifically because it is not a costcutting measure but rather a good
care exercise that it’s been so well
received. It’s good for everyone –
good for doctors who don’t want to
order unnecessary things but often
have pressure to do so. It’s good for
patients because it improves the
quality of care. If it does end up
saving costs, that’s good too.
As told to Prithi Y[Z